Eficacia de una plataforma de telemedicina (Cronex 3.0) en el abordaje de pacientes EPOC con fenotipo agudizador o mixto y frecuentes ingresos hospitalarios: aspectos metodológicos / Efficacy of a telemedicine platform (Cronex 3.0) in approaching patients with exacerbator or mixed-phenotype COPD and frequent hospitalizations: methodological aspects

La prevalencia de EPOC en España es elevada. En el futuro, debido al aumento del tabaquismo y al cambio en la pirámide de edad, se prevé un mayor aumento en la incidencia y en la prevalencia, siendo necesaria la búsqueda de nuevas estrategias y herramientas encaminadas a evitar o disminuir las agudizaciones. En este sentido, un programa de intervención telemática coordinado y dirigido desde el servicio de neumología del hospital a los pacientes con EPOC y fenotipo Agudizador, así como fenotipo mixto con características de reingresadores, podría disminuir los ingresos hospitalarios de estos pacientes y ser asimismo un programa coste-efectivo. El objetivo principal de este artículo fue recoger de forma exhaustiva y ampliada todo lo concerniente al diseño metodológico utilizado en el ensayo clínico denominado CRONEX 3.0 no publicado y que aborda el impacto de la telemedicina en la tasa de reingresos por EPOC y su análisis de coste-efectividad

The prevalence of COPD in Spain is high. In the future, due to the increase in tobacco use and the change in the age pyramid, a greater increase in the incidence and prevalence is expected, making it necessary to find new strategies and tools aimed at avoiding or decreasing exacerbations. In this sense, a coordinated telematic intervention program managed by the pulmonology department at the hospital directed towards patients with exacerbator and mixed-phenotype COPD with characteristics of requiring repeat hospitalizations could decrease hospitalizations in these patients and be a cost-effective program at the same time. The main aim of this article is to comprehensively and broadly include everything not yet published regarding the methodological design used in the clinical trial CRONEX 3.0 and which addresses the impact of telemedicine on the rate of rehospitalizations due to COPD and its cost-effectiveness analysis

Effectiveness of different treatments in obesity hypoventilation syndrome.

Obesity hypoventilation syndrome (OHS) is an undesirable consequence of obesity, defined as daytime hypoventilation, sleep disorder breathing and obesity; during the past few years the prevalence of extreme obesity has markedly increased worldwide consequently increasing the prevalence of OHS. Patients with OHS have a lower quality of life and a higher risk of unfavourable cardiometabolic consequences. Early diagnosis and effective treatment can lead to significant improvement in patient outcomes; therefore, such data has noticeably raised interest in the management and treatment of this sleep disorder. This paper will discuss the findings on the main current treatment modalities OHS will be discussed.

[Overall long-term survival in lung cancer analyzed in 610 unselected patients]. / Supervivencia global a largo plazo en el cáncer de pulmón. Análisis de una serie de 610 pacientes no seleccionados.

INTRODUCTION AND OBJECTIVES: Many studies of lung cancer survival are carried out in patients selected for certain features that usually influence prognosis favorably. The objective of this study was to assess the overall survival of unselected patients with a diagnosis of lung cancer in our practice. PATIENTS AND METHODS: We studied 610 patients for whom survival information was available, a population comprising 88% of the 694 with lung cancer diagnosed in our hospital from 1991 through 1998. The variables analyzed for their correlation with survival were age, sex, histology, tumor-node-metastasis (TNM) stage, treatment, and time of diagnosis (with patients grouped by 2-year periods). RESULTS: The cases of 596 men and 14 women with a mean age of approximately 67 years were studied. Small cell tumors were found in 141, non-small cell tumors in 447, and other tissue types in 22. Surgical excision was carried out on 118 (19.3%), and treatment was confined to control of symptoms for 6.4% of the patients with small cell tumors and 40.5% of those with non-small cell cancer. Symptomatic treatment alone was more common for patients older than 70 years (52.5%) and less common during the last 2 years of the study period (1997-1998: 19%). Overall 5-year survival was 7.9% (2.8% in small cell cancer and 9.4% in non-small cell cancer). Survival rates were lower in patients over 70 years of age. Significant differences in survival were seen for successive TNM stages, with the exception of IIIA and IIIB. The 1997-1998 period saw better survival rates, at 40.8% after 1 year and 11.2% after 5 years. CONCLUSIONS: The survival rates in lung cancer patients in our hospital practice are low because the rate of surgical resections is low owing to the high percentage of cases found in advanced stages. Our observations are similar to those reported from other European countries.